Enhancing the efficacy of local official food controls in Finland

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Department of Food Hygiene and Environmental Health Faculty of Veterinary Medicine

University of Helsinki, Finland Helsinki 2016

ENHANCING THE EFFICACY OF LOCAL OFFICIAL FOOD CONTROLS IN FINLAND

TIINA LÄIKKÖ-ROTO

ACADEMIC DISSERTATION

To be presented, with permission of the Faculty of Veterinary Medicine, University of Helsinki, for public examination in Auditorium 2041, Biocenter 2,Viikinkaari 5, Helsinki,

on November 11, 2016 at 12 noon.

Helsinki 2016

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Supervising Professor

Professor Hannu Korkeala, DVM, PhD, MSocSc Faculty of Veterinary Medicine

Department of Food Hygiene and Environmental Health University of Helsinki, Finland

Supervisors

Docent Mari Nevas, DVM, PhD Faculty of Veterinary Medicine

Docent Janne Lundén, DVM, PhD Faculty of Veterinary Medicine

Reviewed by

Professor Craig Hedberg, MS (Environmental Health), PhD Division of Environmental Health Sciences

School of Public Health

University of Minnesota, United States Riitta Maijala, DVM, PhD

Docent, University of Helsinki Vice President for Research Academy of Finland Helsinki, Finland Opponent

Ari Hörman, DVM, PhD, MPH Docent, University of Helsinki Chief Veterinary Officer Finnish Defense Forces Helsinki, Finland

ISBN 978-951-51-2445-6 (Paperback) ISBN 978-951-51-2446-3 (PDF) Unigrafia

Helsinki 2016

http://ethesis.helsinki.fi

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ABSTRACT

The primary legal responsibility for ensuring food safety in the European Union lies with food business operators. However, official controls shall also be implemented to ensure that food handling complies with the relevant requirements. Level of food safety is thus affected by several factors: the appropriateness of legislation in order to achieve food safety, the compliance of food businesses with legislative demands, and the efficacy of official food controls in verifying and enforcing compliance. The main objective of this work was to examine the factors behind efficacious local official food controls and the possibilities for improving the efficacy of the controls at different levels of the food control chain in Finland. The second objective was to investigate the consistency and quality of the local official food controls and ways to enhance these. To achieve these aims, studies were conducted on four different levels of the food control chain, i.e. level of food business operators, level of official inspecting staff, level of management for the official inspecting staff, and level of auditing of official food controls. Businesses that both prepared and served foods (in this work ‘restaurants’ or ‘restaurant business operators’) were chosen as representatives of food businesses.

Positive correlations were found between the hygiene knowledge of restaurant business operators, their attitudes towards official food control, and the hygiene level of their operations. Proper justification of control measures used by food control officials, provision of guidance, and a negotiative approach in tasks of official food controls appear to be highly important for improving hygiene in food establishments.

Several factors related to the food control official and the working unit of the official may affect the inspection processes and the efficacy of controls. The use of checklists and templates for inspection reports were noted to enhance the consistency and efficacy of controls. The templates also reduced the time used in preparing inspection reports and increased the quality of these reports. Time limits for correcting non-compliances had a significant impact on the efficacy of controls.

Food control units had created adequate working conditions by providing their staff with guidance papers, templates, and possibilities to collectively hold discussions.

However, poor orientation of new staff, non-systematic utilization of tacit knowledge through converting it to explicit knowledge and sharing it, and incomplete commitment among staff to quality systems remain challenges in the units. Insufficient human resources and the inability of heads of food control units to recognize problems in the workplace setting may impair the functional capacity of units. Poor workplace atmosphere and weaknesses in organization of work may be reflected in lesser appreciation of food business operators towards official food controls.

Perceptions of the auditors (regional officials) and of the auditees (municipal officials) differed greatly regarding the adequacy of the auditing system. The regional officials had experienced the auditing visits as clearly more useful and positive than the municipal

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officials and also found the current auditing system to be more suitable for the purpose.

The regional officials did, however, state that the auditing results had not been adequately utilized in planning the guidance and education of professionals working in official food control.

Based on the results of this work, certain weaknesses exist in the efficacy and consistency of local official food controls in Finland. However, several means to improve the efficacy and consistency of the controls were identified on all studied levels of the food control chain. Some of the observed impact possibilities, such as using checklists during inspections and using templates for inspection reports, are relatively simple to implement. Other measures, such as fully implementing risk-based procedures during inspections and more systematic utilization of the tacit knowledge that is present among the official food control staff, would require a substantial amount of time and effort of the food control authorities.

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ACKNOWLEDGMENTS

This study was carried out at the Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, during 2011-2016. The Ministry of Agriculture and Forestry and the Finnish Veterinary Foundation are thanked for financial support.

I am deeply grateful to both of my supervisors; Docent Mari Nevas, the current Head of the Department of Food Hygiene and Environmental Health, and Docent Janne Lundén, for all of their support during the various phases of the project and for sharing their knowledge about the research field. I also thank Mari for initiating this dissertation. I owe my sincere thanks also to Professor Hannu Korkeala, the former Head of the Department, for the opportunity to carry out the project in such an enthusiastic working environment and for his insights and constructive criticism that greatly improved my work.

My sincere gratitude is extended to my coauthors Jaakko Heikkilä and Silja Mäkelä. I also thank Jaakko for his valuable contribution to the project overall. Professors Riitta Maijala and Craig Hedberg are acknowledged for skilfully reviewing this thesis, and Carol Ann Pelli is warmly thanked for editing the English language of the manuscript. My deepest gratitude is also extended to all food business operators and professionals of official food controls who participated in the study or otherwise provided help during the project.

I warmly thank all of my colleagues at the Department of Food Hygiene and Environmental Health. It was a privilege to work in such an inspiring environment, surrounded by such a high level of expertise and knowledge. Special thanks to Professors Maria Fredriksson-Ahomaa and Miia Lindström, Docent Riikka Laukkanen-Ninios, Riikka Keto-Timonen, Annamari Heikinheimo, Suvi Joutsen, Jenni Luukkanen, Karoliina Kettunen, and Maija Summa for interesting discussions during lunch and coffee breaks.

Johanna Seppälä, thank you for saving me so many times in so many ways. I also thank all of my colleagues at Evira. Special thanks go to Auli and Leena for allowing me time for this project and for understanding when my thoughts were scattered in my day-time job due to this work. Carmela and Eeva, thank you for the Monday and Wednesday runs; they were needed. Riina, thank you for sharing the dissertation panic with me. If I could add a smiley here, I would. Eveliina, thank you for all the help and practical advice regarding the dissertation. My sincere thanks are also owed to all others at Evira who showed an interest in my work and supported me or just had the patience to listen to the details of the process in the coffee room: Marina, Pirjo, Anne, Tuula, Noora, Tuuli, Marjo, Paula, Annika, Elina, and Marko, to name but a few. Marjo M., thank you for your encouraging words during our work trips in the very last phases of manuscript writing.

My dear friends in Finland, China, and many other places around the globe are thanked for their support and for believing in me even when I didn’t. Thank you for all the dinners, beers, and drinks; the times spent with you have been an important source of laughter and joy. Special thanks for all those who have joined me (and pushed me) in runs and bike rides. Also, thank you Kevin and Wang Ayi back in Beijing, you’re the best.

My heartfelt thanks go to Professors Wilhelm Tham and Marie-Louise Danielsson- Tham, who have had a major impact on my occupational choices. Wilhelm and Marie-

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Louise gave me the spark for the field of food hygiene, leading me into the world of food science at the beginning of the 2000s. Without them and their overwhelming enthusiasm, my path would likely have been quite different.

I owe a sincere thanks to my mom and dad; first of all for introducing me to veterinary medicine, but also for always supporting me in whatever I chose to do. I’m also grateful to my parents-in-law, who have lightened the load of our everyday lives numerous times.

Thank you all four also for taking such good care of our little furry family members, neiti Nyyssönen and herra Jäppinen. Hanna and Mat, Emppu and Aino, and Heidi and Markus, thank you for your support. It’s good to have you guys around.

Finally, my dearest ones, Harri and Elmeri. Thank you both for unconditional love and patience. You two have seen the ups and downs of this process and supported me the most. Harri, I hope you know that without you this work would never have been done.

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5.4 Unit-related factors affecting municipal food controls (III) 48 5.4.1 Operational functionality and prerequisites for official food controls in the units 48 5.4.2 Importance of work-related well-being for work efficiency in units 49 5.5 Auditing of municipal food control during 2007-2010 (IV) 50

6 DISCUSSION 52

6.1 Enhancing hygiene in food establishments through official food controls at

restaurant level 52

6.1.1 Increasing food safety knowledge 52

6.1.2 Increasing positive attitudes towards official food controls 53 6.2 Enhancing consistency and efficacy in inspection processes 53

6.2.1 Consistency of controls 53

6.2.2 Efficacy of controls 54

6.3 Enhancing quality of official food controls in units 55 6.3.1 Prerequisites for high-quality effective controls 55

6.3.2 Significance of work-related well-being 56

6.4 Improving official food controls through the national auditing system 57

7 CONCLUSIONS 59

REFERENCES 61

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LIST OF ORIGINAL PUBLICATIONS

This thesis is based on the following publications, which are referred to in the text by their Roman numerals:

I Läikkö-Roto, T., and Nevas, M. 2014. Restaurant business operators’

knowledge of food hygiene and their attitudes toward official food control affect the hygiene in their restaurants. Food Control 43:65-73.

II Läikkö-Roto, T., Mäkelä, S., Lundén, J., Heikkilä, J., and Nevas, M. 2015.

Consistency in inspection processes of food control officials and efficacy of official controls in restaurants in Finland. Food Control 57:341-350.

III Läikkö-Roto, T., Lundén, J., Heikkilä, J., and Nevas, M. 2016. Prerequisites for effective official food control. Food Control 61:172-179.

IV Läikkö-Roto, T., and Nevas, M. 2014. Auditing local official food control:

Perceptions of auditors and auditees. Food Control 37:135-140.

These articles have been reprinted with the kind permission of their copyright holder Elsevier B.V.

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ABBREVIATIONS

COM Commission of the European Communities

EC European Commission

EFSA European Food Safety Authority

EU European Union

FBO Food Business Operator

FSA UK Food Standards Agency of the United Kingdom HACCP Hazard Analysis and Critical Control Points

IBM International Business Machines Corporation INTOSAI International Organization of Supreme Audit Institutions MAF Ministry of Agriculture and Forestry, Finland

PASW Predictive Analytics Software RBO Restaurant Business Operator SME Small and Medium-sized Establishments SPSS Statistical Product and Service Solutions US FDA United States Food and Drug Administration VFM Value For Money

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1 INTRODUCTION

Food safety is a result of several factors: legislation lays down minimum hygiene requirements, food business operators (henceforth FBOs) establish and operate food safety programs and procedures based on HACCP (Hazard Analysis and Critical Control Points) principles, and official controls ensure compliance of FBOs and foodstuffs (EC No 852/2004). Responsibility for food safety was previously more strongly placed on governments and official food control authorities (Henson & Caswell, 1999; Halkier &

Holm, 2006). However, increasing numbers of recorded food-borne illnesses and high- profile outbreaks such as the BSE (bovine spongiform encephalitis, commonly known as

‘mad cow disease’) crisis in 1996 created both political and economic demands for more effective food safety controls (Halkier & Holm, 2006; Varzakas et al., 2006; Garcia Martinez et al., 2007; Bánáti, 2014). It was understood that the difference between the industry responsibility i.e. HACCP-based procedures, and the government responsibility, i.e. monitoring and assessing the proper implementation of these procedures, should be clarified (Ababouch, 2000; Motarjemi, 2000). The European Commission published the

“White paper on food safety”, laying the foundation for establishment of the European Food Safety Authority EFSA and outlining a radical revision of the food safety hygiene rules in the European Union (henceforth EU) (COM, 1999; Halkier & Holm, 2006).

Regarding food production in the EU, the primary legal responsibility for ensuring food safety now lies with FBOs (EC No 178/2002). However, the member states are obliged to implement official controls in order to monitor and verify that the operators comply with the relevant requirements for ensuring the safety of their operations and protecting consumer rights at all stages of the operations (EC No 882/2004). Sufficient and appropriately trained staff shall perform the tasks, and adequate facilities and equipment shall be in place to complete controls (EC No 882/2004; EC No 677/2006). To verify whether the official food controls are effectively implemented and suitable for achieving the objectives of the relevant legislation, competent authorities shall implement audit systems (EC No 882/2004; EC No 677/2006).

This thesis concentrates mainly on the roles of FBOs and enforcers of food legislation in enhancing food safety, and on interactions between these actors. Factors affecting the efficacy of official food controls at different levels of the food control chain in Finland are discussed. Efficacious official food controls should be realized as appropriate verification and enforcement of compliance with food safety legislation. Assuming that the hygiene legislation is appropriate for achieving better food safety, and that the food businesses do not always comply with the hygiene rules, appropriate verification and enforcement should ultimately result in better food safety. However, both human factors and factors related to control systems may either strengthen or weaken this development, which is why their significance should be investigated.

‘Effectiveness’ or ‘efficacy’ in general language describes the power or capacity of something to produce a desired or intended result or effect (Cambridge Dictionary .com;

Oxford Dictionaries .com; The Free Dictionary .com). However, the definitions of the terms differ somewhat between the different fields of science. In public administration, the term ‘efficacy’ can be used according to the general meaning, whereas ‘effectiveness’ also

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includes an assessment of how well or to what extent the stated objectives are achieved as measured by a given set of criteria (Public Administration Dictionary, 1995; International Dictionary of Public Management and Governance, 2015). Compared with ‘efficacy’, the term ‘effectiveness’ is also more easily confused with the term ‘efficiency’. Thus, in this thesis ‘efficacy’ is used when referring to the ability of the official food controls to make an impact on food safety.

The term ‘efficiency’ (operational efficiency, work efficiency, employee efficiency) is included in this work. Efficiency describes a process that uses the lowest amount of inputs to create the greatest amount of outputs. Thus, operational efficiency, work efficiency, or employee efficiency describes the ability of an employee or a working community as a whole to accomplish their desired goals with the least waste of resources such as time, effort, and money.

In accordance with Regulation EC No 852/2004, the terms ‘establishment’ and ‘food establishment’ cover any unit of a food business in this thesis. The term ‘retail food establishment’ is used for those establishments that prepare foods for direct use of final consumers. The term ‘manufacturing establishment’ is used for establishments that process foods for later handling of other food businesses.

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2 REVIEW OF THE LITERATURE

2.1 Legislative framework for food production

It is necessary to establish formal policies, such as direct regulation to manage risks in food production, but the overall impact of legislation depends on the intended level of food safety (Antle, 1999). Food safety legislation reduces risks of morbidity and mortality associated with consuming foods contaminated with microbial pathogens and other hazards (Antle, 1999). However, regulation also imposes additional burdens and costs on businesses, such as the cost of compliance, the cost of more paperwork, and the costs of official controls (Antle, 1999; Kaplowitz & Eyck, 2006). Risk-based regulation responds to calls to reduce the administrative burden of regulation on food businesses and to promote more efficient approaches to regulatory enforcement (Garcia Martinez et al., 2013).

Jouve (1998) concluded already in 1998 that food safety legislation should be science- based, apply risk assessment, be proportional to real health risks, be preventive in nature, include all aspects of food safety and the food system, be flexible enough for changes, define needed authority and responsibilities, and provide means for consistent implementation and adequate enforcement. These principles were included in the European food safety legislation during 2002-2004, and the current legislation is considered more risk-based and flexible and also better matched to the needs of food establishments and enforcement than its predecessors (Garcia Martinez et al., 2013). The establishment of EFSA has strengthened risk assessment in the decision-making process, but since the risk management remains in the hands of the member states, it may include variability (Caduff & Bernauer, 2006). The requirement for implementing HACCP-based practices in food safety legislation has also been stated to have a very uneven effect on businesses because of HACCP’s strong reliance on science; many small producers lack the expertise and resources to adapt to HACCP, forcing some of them out of business (Wengle, 2015).

Regarding food production in the EU, the given rules mainly consist of legislation common to all member states, provided by the European Parliament and Council or by the European Commission. According to Regulation EC No 178/2002, all FBOs shall ensure and verify that the foods under their responsibility are in compliance with the relevant requirements at all stages of production, processing, and distribution. The common principles for the hygienic handling of foods in any food business in the EU are laid down in Regulation EC No 852/2004. These hygiene principles include, among others, the structural, operational, and hygiene requirements for food establishments, the implementation of good hygiene practices and HACCP-based procedures in food production, and the obligation to provide possibilities for relevant hygiene training and HACCP training for the food operating staff (EC No 852/2004). In Finland, the requirements set in the aforementioned regulations are further specified in national legislation: all food handlers working for longer than three months in food establishments must have a Food Hygiene Proficiency Certificate to reflect their knowledge of food

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hygiene, and the own-checking programs of food businesses shall describe how adequate hygiene knowledge in food handling is ensured in their operations (Finnish Food Act 23/2006; MAF No 1367/2011; MAF No 795/2014).

2.2 Critical but common hygiene deficiencies in food production Avoidance of cross-contamination, applying good personal hygiene, keeping food at safe temperatures, and adequate cooking are among the most important factors for food safety (US FDA, 2009; Pham et al., 2012). For example, proper hand washing and proper use of gloves are efficient and convenient ways to reduce pathogens from hands and to avoid cross-contamination (Todd et al., 2010a, 2010b). However, food businesses do not always comply with the rules, and their practices may differ substantially from the legislative requirements (Henson & Heasman, 1998; Clayton et al., 2002; Walczak & Reuter, 2004;

Veiros et al., 2009). Poor personal hygiene, contaminated equipment, improper holding temperatures, and inadequate cooking have been reported as food safety violations that typically cause food-borne illnesses (Collins, 1997; Buchholz et al., 2002; Roberts et al., 2008). Critical food safety violations in retail food establishments, such as commercial restaurants, catering businesses, cafés, hospital kitchens, school kitchens, and hotel kitchens, are widely reported in the literature (Table 1).

Table 1 Critical food safety violations in retail food establishments both preparing and serving foods reported in the literature.

Food safety violation Reference Inadequate temperatures and

inadequate temperature control

Walker et al., 2003b; Phillips et al., 2006; Hadjichristodoulou et al., 2008; Roberts et al., 2008; Campos et al., 2009; Garayoa et al., 2011; Marzano & Balzaretti, 2011; Niode et al., 2011;

Djekic et al., 2014; Garayoa et al., 2014; Martins & Rocha, 2014

Deficient hand hygiene Phillips et al., 2006; Campos et al., 2009; Buccheri et al., 2010;

Niode et al., 2011; Sheth et al., 2011; Tan et al., 2013; Boxman et al., 2015

Obvious risks for cross- contamination in operations

Walker et al., 2003b; Roberts et al., 2008; Campos et al., 2009;

Buccheri et al., 2010; Sheth et al., 2011; Djekic et al., 2014;

Garayoa et al., 2014; Boxman et al., 2015

Poor cleaning and disinfection practices

Legnani et al., 2004; Garayoa et al., 2011; Martins & Rocha 2014

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In a study addressing Finnish food stores, temperature violations were observed in 50% (42/84) of the products on sale, and 18% (15/84) of the products exceeded the legislative temperature limits by over 3°C for more than 30 min (Lundén et al., 2014b). In 2009, hygiene level in Finnish professional kitchens was found to be generally acceptable;

about 11% (22/198) of the kitchens were responsible for all unacceptable hygiene scores, the highest hygiene-related risks occurring in food storage and different operational steps of meal preparation (Tuominen & Maijala, 2009).

2.3 Determinants for hygiene level in food establishments

There are a number of factors related to food businesses that have been shown to have an effect on their hygiene level. Both the infrastructural needs and the human factor must be recognized as determinants for hygiene and food safety (Fotopoulos et al., 2009).

Maintaining food safety culture successfully requires that the operators and staff know the risks associated with the foods they handle, know why managing the risks is important, and effectively manage these risks in practice (Powell et al., 2011). The right attitude together with the needed knowledge, skills, and support will lead to the required performance with a high probability (Pilling et al., 2008).

It has been generally accepted by enforcers and other food safety experts that there will always be a sector of businesses that will not comply with food legislation, either consciously or due to a lack of knowledge (Clayton et al., 2002; Fairman & Yapp, 2004;

Walczak & Reuter, 2004; Kaplowitz & Eyck, 2006; Sheth et al., 2011). Conscious decisions about whether or not to comply with safety regulations are based on different kinds of cost-benefit analysis, where the cost of the needed measures and the knowledge and attitude of the FBO all have important roles (Walczak & Reuter, 2004). Differences exist in the specific manner in which individual businesses comply with food safety regulations, but the process that leads to the decisions regarding compliance follows a common sequence of events (Henson & Heasman, 1998). These events include becoming aware of a new regulation, interpreting the effects of the new regulation on the business, and identifying the changes required to achieve compliance (Henson & Heasman, 1998).

To diminish the effect of a lack of knowledge of FBOs for non-compliance, enforcement practices in the EU have moved from punishment to prevention by providing incentives and information (Rouvière & Caswell, 2012).

2.3.1 Operational aspects and size of business

Operational type of the food business is one determinant for food safety; for example, restaurants are more commonly reported to have problems in hygiene than other operation types preparing and serving foods (Tuominen & Maijala, 2009; Lee et al., 2012; Kwon et al., 2014). In Finland, the most common infection locations for food-borne outbreaks during 2000-2014 have been restaurants, cafés, and hotels, with, for example, 20/36 (56%) outbreaks in 2014, 23/43 (53%) outbreaks in 2013, 19/43 (44%) outbreaks in 2012 and

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25/45 (56%) outbreaks in 2011 (Finnish Zoonosis Centre, 2016). Of the reported non- compliances in connection with the outbreak operators during 2014, 44% were associated with incorrect temperatures in storing or handling of foodstuffs, and infected food workers combined with deficient hand hygiene caused 14% of the food-borne outbreaks (Finnish Zoonosis Centre, 2016). Norovirus was the most commonly detected causative agent: of 36 food-borne outbreaks, norovirus was the causative agent in 22% (8 outbreaks) (Finnish Zoonosis Centre, 2016).

Complexity of operations appears significant within the different operation types; for example, restaurants with relatively simple menus tend to receive higher inspection scores than ones that use more complex menus with more involved preparation methods (Seiver

& Hatfield, 2000). Membership to a chain may have an impact on hygiene level, but the results are conflicting: the effect of being a member of a chain has been reported both to increase hygiene (Jin & Leslie, 2009; Kassa et al., 2010; Murphy et al., 2011; Harris et al., 2014) and to weaken it (Phillips et al., 2006).

The strongest determinant for food safety and compliance with regulations according to the literature appears to be the size of the business. Small businesses generally implement regulation at a later stage and are more likely to choose partial compliance or non-compliance than large businesses (Henson & Heasman, 1998). Barriers for food safety in small and medium-sized establishments (SMEs) and microbusinesses are widely reported. These barriers include, among others, lack of adequate prerequisite programs and manager commitment, time constraints, and lack of money (Lange et al., 2000; Panisello

& Quantick, 2001; Taylor, 2001; Clayton et al., 2002; Bánáti, 2003; Yapp & Fairman, 2006; Celaya et al., 2007; Kaario et al., 2007; Violaris et al., 2008; Fielding et al., 2011).

Food safety violations have been reported to be positively related to the amount of work the cooks have to do and inversely related to the amount of time used for cleaning and sanitizing (Walczak & Reuter, 2002). Regression model has shown that the adequacy of buildings and facilities improves the observed practices (da Cunha et al., 2014), but small producers often lack possibilities to invest in updating plant facilities or equipment to compliance levels (Wengle, 2015). If legislation lowers the profits and productivity of a food business, the FBO may experience the rules as unfair, oppressive, ambiguous, unjustified, or unnecessary (Walczak & Reuter, 2004). Since SMEs and microbusinesses may lack expertise and resources to adapt adequate food safety systems (Fielding et al., 2011; Luning et al., 2013; Dzwolak, 2014; Fernando et al., 2014; Wengle, 2015), HACCP regulations may pose insurmountable challenges for some of them (Wengle, 2015).

Additionally, since the smaller businesses more often lack the skill and knowledge necessary for them to be able to identify risks in their operations and hazards within their premises (Fairman & Yapp, 2004; Yapp & Fairman, 2006; Nevas et al., 2013), the primary motivation to improve food safety conditions will not come from within the food business, but will be provided by external drivers such as enforcement agency staff (Fairman & Yapp, 2004, 2005). This includes a risk for the enforcers to end up as permanent drivers for compliance instead of the businesses taking the responsibility themselves (Fairman & Yapp, 2004, 2005). The ability and willingness of SMEs to provide training to their staff may also be limited (Lange et al., 2000).

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A large majority of FBOs belong to the group of SMEs or microbusinesses both in the EU (Eurostat, 2011) and in Finland (National register for municipal food control data, 2015). Several studies conclude that governmental agencies should provide more help for SMEs and microbusinesses to implement safe behaviors (Vela & Fernández, 2003;

Kramer & Scott, 2004; Violaris et al., 2008; Luning et al., 2015). Further flexibility and simplification of the system have also been suggested (Dzwolak, 2014). However, since the small businesses may allocate the responsibility for identifying problems to the enforcers and not to themselves (Fairman & Yapp, 2004), they should primarily be supported in developing their own risk management. Food legislation of the EU includes a mechanism of national guides for good hygiene practices, designed for sharing ready- made inter-branch specific models of good practices for businesses that may lack the expertise to produce such models by themselves (EC No 852/2004). However, in Finland only seven approved guides for good hygiene practices have been taken into use for the food chain (Evira, 2015a).

2.3.2 Food safety systems

Food safety systems rely on successful determination of food safety hazards, an acceptable level of risk to the consumer, and effective measures for control of these risks (Manning, 2013). Product safety and quality improvement, increased customer confidence, and improved compliance with regulatory requirements motivate the businesses to adapt food safety systems (Mensah & Julien, 2011; Wilcock et al., 2011; Fernando et al., 2014).

According to several studies, well-functioning food safety systems lead to increased food safety (Legnani et al., 2004; Eves & Dervisi, 2005; Nielsen, 2006; Hadjichristodoulou et al., 2008; Lindblad & Berking, 2013; Djekic et al., 2014). Attitudes of Finnish FBOs toward food safety systems have been shown to be positive (Hielm et al., 2006), but implementation of the systems may prove inadequate or lacking (Tuominen & Maijala, 2009; Lundén et al., 2014b).

The most widely known food safety systems include HACCP, also required for food businesses in Europe by Regulation EC No 852/2004. HACCP started as a voluntary approach by the industry, emerging as the food safety system of choice in the 1990s (Lee

& Hathaway, 2000; Sperber, 2005). With HACCP, the focus in food safety has shifted from end-product to process, and the surveillance of operations has become more detailed and systematic (Nielsen, 2006). However, simply conforming to HACCP requirements does not guarantee that a food company is able to reach the highest product safety performance, and HACCP system should not be seen as an omnipotent solution (Bánáti &

Lakner, 2012; Kafetzopoulos et al., 2013). The sought improvement in food safety by implementing the HACCP system is realized only if HACCP has a strong foundation in good manufacturing and hygiene practices (Sperber, 1998; Ababouch, 2000; Mortimore, 2001; Wallace &Williams, 2001; Baş et al., 2006a, 2007; Fotopoulos et al., 2009) and if the people charged with the management and implementation have the knowledge and expertise to apply the system effectively (Khandke & Mayes, 1998; Aruoma, 2006;

Jevšnik et al., 2008; Mensah & Julien, 2011).

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Weaknesses in implementation of prerequisites and HACCP have been reported in retail food establishments (Doménech et al., 2011; Garayoa et al., 2011), and several general barriers for implementation related to managerial, organizational, and technical issues have been identified (Taylor, 2001). Barriers identified in both retail food establishments and manufacturing establishments include complicated terminology (Mitchell, 1998; Baş et al., 2007), weak understanding of the general HACCP principles (Kvenberg et al., 2000; Vela & Fernández, 2003; Baş et al., 2007), and weak understanding of the prerequisite programs and of the relationship between prerequisite programs and HACCP (Mortimore, 2001; Wallace &Williams, 2001; Vela & Fernández, 2003; Sperber, 2005). The process of hazard analysis is weakened by poor knowledge to conduct complete hazard analysis and by difficulties in identifying hazards (Mitchell, 1998; Eves & Dervisi, 2005; Ryu et al., 2013; Wallace et al., 2014). Inadequate facilities and equipment, lack of financial resources, time-related issues, failures in motivating staff to perform according to plan, and inadequate training of managers and staff have been reported as reasons for inadequate implementation (Panisello & Quantick, 2001; Walker et al., 2003b; Strohbehn et al., 2004; Eves & Dervisi, 2005; Baş et al., 2006a, 2007; Garayoa et al., 2011; Mensah & Julien, 2011).

2.3.3 Supervision and management commitment

Successful implementation of food safety systems requires commitment by both managers and food handlers (Jevšnik et al., 2008; Djekic et al., 2011; Powell et al., 2011; Wilcock et al., 2011; Wu, 2012). Appropriate food safety practices require adequate environments, skills and knowledge, and motivational support (Clayton et al., 2002; Allwood et al., 2004; Jevšnik et al., 2008; Fotopoulos et al., 2009; Djecik et al., 2011; Soon et al., 2012).

Managers thus have an important responsibility in ensuring that food workers receive the needed food safety training on a regular basis, that supervision and evaluation of operations are continuous, and that proper facilities are provided (Ehiri et al., 1997;

Panisello & Quantick, 2001; Clayton et al., 2002; Seaman & Eves, 2006; Egan et al., 2007; Howells et al., 2008; Pilling et al., 2008; Seaman, 2010; Seaman & Eves, 2010;

Garayoa et al., 2011; Niode et al., 2011; Wilcock et al., 2011; Medeiros et al., 2012; Wu, 2012; Saccol et al., 2013; Martins & Rocha, 2014). Managers should also focus on providing a sound role model, motivating the food handlers to adopt safe food handling practices, and developing and creating an appropriate organizational climate to promote such practices (Panisello & Quantick, 2001; Seaman & Eves, 2006; Howells et al., 2008;

Pilling et al., 2008; Seaman, 2010; Seaman & Eves, 2010; Lee et al., 2013). General attitudes of managers towards food hygiene and hygiene culture of establishments appear highly significant for the hygienic situation in practice (Clayton et al., 2002; Wilcock et al., 2011; Bánáti & Lakner, 2012). According to Kaplowitz & Eyck (2006), greater management commitment to food safety leads to increased food safety commitment by food workers, which in turn is associated with reduced opposition to regulation.

Certified food managers (managers who have received a certificate upon completion of a food safety training course) have been reported to have a positive effect on food safety.

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In a study performed by Hedberg et al. (2006), the presence of a certified kitchen manager was reported to result in less bare hand contact with foods and noted to be the major difference between outbreak and non-outbreak restaurants. Allwood et al. (2004) found a strong positive correlation between the person in charge being a certified food manager and being able to describe the food code hand washing procedure, which in turn led to food workers being able to demonstrate code-compliant hand washing. Presence of a certified kitchen manager has also been found to decrease several types of critical violations in the operations, facility, and equipment of food establishments (Cates et al., 2009; Kassa et al., 2010). Additionally, certified kitchen managers appear to have more positive attitudes about offering food safety training to their staff and also improving the quality of informal on-the-job training (Cates et al., 2009; Roberts & Barret, 2009).

2.3.4 Knowledge and skills of food handlers

Food hygiene knowledge and skills for adequate food handling are crucial for safe food production. Hygiene situation in food establishments has been found to correlate positively with the level of knowledge of food workers (Tuominen & Maijala, 2009; da Cunha et al., 2014), and food managers have been reported to consider good food safety knowledge among food workers as the most important factor for food safety (Kramer &

Scott, 2004). Despite this, critical knowledge gaps of food workers in retail food establishments in both preparing and serving foods are widely reported in the literature (Table 2). Higher age, more work experience, and higher educational level may increase food hygiene knowledge of food handlers (Çakıroğlu & Uçar, 2008; Buccheri et al., 2010;

Martins et al., 2012; Soares et al., 2012; McIntyre et al., 2013; Tan et al., 2013; da Cunha et al., 2014; Martins et al., 2014; Pichler et al., 2014).

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Table 2 Reported knowledge gaps of food workers leading to inadequate hygiene conditions and hazardous operations in retail food establishments both preparing and serving foods. Some of the references include also manufacturing establishments in their study population.

Knowledge gap Reference

Adequate temperatures and temperature control

Walker et al., 2003a; Baş et al., 2006b; Gomes-Neves et al., 2007; Jevšnik et al., 2008; Santos et al., 2008; Tokuç et al., 2009;

Jianu & Chiş, 2012; Martins et al., 2012; Soares et al., 2012; Ko, 2013; Osaili et al., 2013; Martins et al., 2014; Pichler et al., 2014;

Sani & Siow 2014

Cross-contamination issues Baş et al., 2006b; Gomes-Neves et al., 2007; Santos et al., 2008;

Jianu & Chiş, 2012; Mulugeta & Bayeh, 2012

Cleaning of instruments and working surfaces

Walker et al., 2003a, 2003b; Gomes-Neves et al., 2007; Soares et al., 2012

Microbiological risks, food poisoning and pathogens

Walker et al., 2003a; Gomes-Neves et al., 2007; Bolton et al., 2008; Jevšnik et al., 2008; Santos et al., 2008; Violaris et al., 2008; Tokuç et al., 2009; Jianu & Chiş, 2012; Martins et al., 2012;

Soares et al., 2012; Osaili et al., 2013; Tan et al., 2013; Verhoef et al., 2013; Martins et al., 2014; Sani & Siow 2014

HACCP system Walker et al., 2003b; Eves & Dervisi, 2005; Baş et al., 2007;

Bolton et al., 2008

Connections between training and hygiene knowledge are widely reported (Baş et al., 2006b; Roberts et al., 2008; Santos et al., 2008; Jianu & Chiş, 2012; Mulugeta & Bayeh, 2012; Soon et al., 2012; Osaili et al., 2013; Pichler et al., 2014). Training has been reported to lead to increased compliance with regulations, a reduction in critical violations, and an increased level of awareness and sense of responsibility in food handlers regarding food hygiene (Mathias et al., 1995; Legnani et al., 2004; Thompson et al., 2005; Noble et al., 2009; Choudhury et al., 2011; Garayoa et al., 2014; Martins & Rocha, 2014).

Provision of training courses is also considered crucial for achieving positive behavioral changes (Acikel et al., 2008, Campos et al., 2009; Medeiros et al., 2011; Martins et al., 2012; Saccol et al., 2013). However, increasing knowledge alone may be insufficient to achieve safe behaviors (Powell et al., 1997; Bolton et al., 2008; Santos et al., 2008;

Buccheri et al., 2010; Sani & Siow, 2014). Some studies have shown that training has led to improved knowledge, but not to improved hygiene practices (Buccheri et al., 2010;

Park et al., 2010; da Cunha et al., 2014). Additionally, not all training provides the knowledge needed (Ehiri et al., 1997; Powell et al., 1997).

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22 2.3.5 Attitude and motivation of food handlers

A positive attitude of food handlers towards food safety in general is important due to its positive effect on hygiene performance (Ko, 2010; Bánáti & Lakner, 2012; Aziz & Dahan, 2013; Lee et al., 2013). Lack of motivation to perform correctly may result in, for example, poor personal hygiene (Tuominen & Maijala, 2009). A person’s own belief about the safety of food is a powerful predictor for attitudes towards regulation – the food workers who are more convinced that food is safe in general are more opposed to food safety regulation (Kaplowitz & Eyck, 2006). It has not, however, been studied how the attitudes of FBOs towards the official food controls or their quality experience regarding these controls affect the corrective action performance and the hygiene status of their businesses.

The links between positive behavior, attitudes, and continuous training of food handlers regarding safe food handling are apparent (Seaman & Eves, 2006; Gomes-Neves et al., 2007; Pilling et al., 2008; Buccheri et al., 2010; Abdul-Mutalib et al., 2012; Ko, 2013; Sani & Siow, 2014). Food safety training may improve attitudes towards performing adequate hygiene practices (Soon et al., 2012; McIntyre et al., 2013).

However, if the attitudes towards skills development are negative or indifferent, training opportunities will not be sought and exploited (Lange et al., 2000; Panisello & Quantick, 2001). Incorrect training also fails to improve the attitudes (Baş et al., 2006b; da Cunha et al., 2014). Furthermore, the same problem is apparent regarding attitude as with knowledge; although food workers might have positive attitudes about safe practices, the practices may not be fully implemented (Tokuç et al., 2009; Soares et al., 2012).

According to a number of authors, one of the main reasons for the lack of effectiveness of training in food hygiene is related to the knowledge-attitude-practices model adopted in most of the training programs (Ehiri et al., 1997; Coleman & Roberts, 2005; Egan et al., 2007). This model is based on the assumption that if information is provided to the food handlers they will use it to change behavior, but the model does not consider the effect of other relevant factors, such as pedagogical and motivational factors, on success (Rennie, 1995; Ehiri et al., 1997; Coleman & Roberts, 2005; Seaman & Eves, 2006; Martins et al., 2014).

2.4 Effective training programs for safe food production

The primary aim for food hygiene training is a change in behavior towards less risky food handling practices (Seaman & Eves, 2006; Egan et al., 2007; Yiannas, 2015). However, the content of training programs must be relevant and training needs should be assessed before designing the programs (Seaman & Eves, 2006; Seaman, 2010; Chapman et al., 2011; Martins et al., 2012; Garayoa et al., 2014; Martins et al., 2014). Successful communication requires investment of time and effort to uncover what people already know, what they believe, and how they best receive and understand information (Jardine, 2003). The message should also be simple; food safety messages that are difficult to receive or understand are easily disregarded (Jacob et al., 2010; Papadopoulos et al.,

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2012). To be effective, training should be developed based on the concept of risk, and learning motivation of the employees should be increased by clear consequences for non- compliances and improper food handling and by stressing the importance of the actions of food workers (Clayton et al., 2002, Coleman & Roberts, 2005; Santos et al., 2008;

Chapman et al., 2011; Niode et al., 2011; Sarter & Sarter, 2012; Kim et al., 2013; Martins et al., 2014).

Alternative strategies, such as online learning and interactive media, flyers and booklets, and displaying encouraging posters or signs in food establishments, should be used during the training processes (Howells et al., 2008; Pilling et al., 2008; York et al., 2009; Buccheri et al., 2010; Medeiros et al., 2011). Job-specific training with a practical approach should be included in the training processes (Lange et al., 2000; Jevšnik et al., 2008; Park et al., 2010; Soares et al., 2013; Tan et al., 2013). Training programs should also be assessed, including evaluation of the training process, of increased knowledge, and of behavioral change results (Seaman & Eves, 2006; Egan et al., 2007; Seaman, 2010;

Jianu & Chiş, 2012; Soares et al., 2012; Osaili et al., 2013; da Cunha et al., 2014).

Food workers should be regularly reminded of performing the right behaviors with, for instance, post-training monitoring of the practices and feedback, and refresher training should be provided periodically (Acikel et al., 2008; Çakıroğlu & Uçar, 2008; Soon et al., 2012; McIntyre et al., 2013; da Cunha et al., 2014; Sani & Siow, 2014). To be effective in practice, food hygiene training thus needs continuous managerial support and the support of colleagues (Seaman & Eves, 2006; Egan et al., 2007; Pilling et al., 2008; Seaman, 2010; Seaman & Eves, 2010; Soon et al., 2012). A combination of training and intervention practices addressing typical barriers for food safety has been found to be more effective than relying on training alone (Howells et al., 2008; York et al., 2009;

Lindblad & Berking, 2013).

The combination of incentives, technical support, and training programs is suggested as an approach also for food safety authorities to adopt (Rouvière & Caswell, 2012).

Examples of well-functioning governmental methods have been reported. For instance, due to having had only a little progress with HACCP, the Food Standards Agency of the United Kingdom applied an alternative system of ‘safe methods’ for caterers and retailers in 2006 (Taylor, 2008; FSA UK, 2015). ‘Safe methods’ include more practical guiding and training and prescribed safe methods for cooking, chilling, cleaning, avoiding cross- contamination, and management control. Positive implications on food safety control and attitudes were reported, and positive effects on manager involvement, more clearly defined responsibilities, and increased staff involvement and willingness to act accordingly were noted because of giving them the reasons ‘why’ (Taylor, 2008).

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24 2.5 Official food controls

2.5.1 Regulation on official food controls in Europe and Finland

According to Regulation EC No 882/2004, official food controls should be carried out regularly, on a risk basis, and with appropriate frequency. The controls shall cover all stages of production, processing, and distribution of foods. To ensure the efficacy of the controls, the competent authorities should have a sufficient number of suitably qualified and experienced staff and also possess adequate facilities and equipment to carry out their duties properly (EC No 882/2004).

In Finland, official food controls are included in the concept of environmental health, the implementation of which at the local level shall be organized in municipal cooperation areas (Finnish Act on the Environmental Health Cooperation Areas 410/2009).

Municipal food control authorities and these cooperation areas are responsible for official food controls in all food establishments in municipalities, except for slaughterhouses and associated establishments (Finnish Food Act 23/2006). The Regional State Administrative Agencies have the obligation to guide and evaluate the municipal food control, and the Finnish Food Safety Authority Evira (henceforth Evira) is responsible for the national guidance of food control regulations (Finnish Food Act 23/2006). Shared responsibility between different authorities in food control activities has, however, been reported to often result in lack of coordination and efficiency, and to cause gaps and overlaps in the control system (deWaal, 2003; Varzakas et al., 2006; Al-Kandari & Jukes, 2012; Ayalew et al., 2013; Hadjigeorgiou et al., 2013; Jia & Jukes, 2013; Smigic et al., 2015).

In order to build a legislative framework for public administration in Finland, the Finnish Administrative Procedure Act 434/2003 establishes principles for good governance, and the Finnish Local Government Act 410/2015 lays down general rules regarding the organization of public administration in municipalities. However, the Finnish Constitution Law 731/1999 gives the municipalities a strong self-determination right, which may lead to differing organization of official food controls and varying provision of the needed prerequisites for the controls (such as adequate number of staff, adequate facilities and equipment, or possibilities for training) between the different cooperation areas. In fact, differences have been reported between municipal food control authorities regarding the resources available for food controls and the collected control fees from FBOs, the purpose of which is to ensure sufficient resources (Tähkäpää et al., 2008; Tähkäpää et al., 2009; Lepistö et al., 2010; Tähkäpää et al., 2013). According to Tähkäpää et al. (2008), local decisions concerning the structure of control organs can have considerable consequences on the controls; factors such as low number of food experts in the municipal council could lead to inadequate resources in local official food control.

Different possibilities for organization of the system in Finland have been discussed (Niemi, 2002; Hirn, 2011; Nevas & Lepistö, 2015; Tarasti, 2016), but so far only meat inspection and control of foods of animal origin received from other member states of the EU have been centralized to the state (Amendment of the Finnish Food Act, 352/2011).

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25 2.5.2 Role of inspections

The main objective of official controls in general is to verify compliance with given rules.

Official food controls have a fundamental role in ensuring food safety through reduction of violations of regulation, and thus, presumably also the number of food-borne outbreaks (May, 2004; Doménech et al., 2011; Kwan & Lau, 2011; Murphy et al., 2011). Lundén et al. (2014a) showed that the risk management systems of the operators in Finnish retail shops are not necessarily reliable, and that official control visits in food establishments are thus crucial. Since the risk management systems proved unreliable, Lundén et al. (2014a) also concluded that inspection frequencies should not be decreased at least solely based on the own-checking results of FBOs.

The impact of inspection frequency on compliance level of food establishments has been studied, but the results are contradictory. According to Mathias et al. (1995) and Allwood et al. (1999), the compliance level of a restaurant is increased with higher inspection frequency, whereas Newbold et al. (2008) found no impact of increased inspection frequency on the number of violations. More frequent inspection visits have been suggested to have a positive effect on the understanding of FBOs about the relevance of non-compliances for food safety when the food safety risks within the processes of the inspected food establishments are openly discussed between inspectors and the FBOs (Nevas et al., 2013). Inspections may thus have an important role in preventing food-borne illness through advice and guidance given to food workers (Fairman & Yapp, 2004, 2005;

Newbold et al., 2008; Nevas et al., 2013).

Education, educational communication, and enforcement all have important roles in promoting safe behaviors in food production (Fairman & Yapp, 2004; Murphy et al., 2011; Lindblad & Berking, 2013), but cooperation and an educational control approach are stated to be even more efficient in improving compliance than penalty-based enforcement (Allwood et al., 1999; May, 2004; Fairman & Yapp, 2005; Reske et al., 2007; Choi et al., 2011). No previous research has, however, been conducted on the effects of different factors related to official food controls and inspectors for the quality experience of FBOs regarding these controls.

2.5.3 Routine inspections as predictors for food-borne outbreaks

Results regarding the power of inspection results in predicting food-borne outbreaks are controversial; positive correlations between the number of non-compliances or rankings given by food control officials and food-borne outbreaks have been reported (Irwin et al., 1989; Buchholz et al., 2002; Petran et al., 2012), while others have stated that inspection results are poor predictors of food-borne outbreaks (Jones et al., 2004; Powell et al., 2013;

Leisner et al., 2014). What is clear is that inspections cannot always prevent disease outbreaks (Allwood et al., 1999).

A variety of factors influences the reliability of routine inspections in preventing food- borne outbreaks (Jones et al., 2004). An inspection conducted during a busy mealtime may, for example, reveal especially those non-compliances that are related to the hectic

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working pace (Petran et al., 2012). Failures in inspection practices may exist, and if food control officials therefore fail to detect the existing deficiencies and weaknesses in critical aspects for food safety, the inspection results will not be successful predictors or preventers of food-borne outbreaks (Irwin et al., 1989; Powell et al., 2013).

The most commonly cited violations in the inspection reports tend not to be the critical items for food safety (Jones et al., 2004; Hadjichristodoulou et al., 2008; Sharkey et al., 2012; Green & Kane, 2014). One explanation for enforcing more of the visually apparent and rule-based items compared with the significant risks within the processes of food businesses may be the fact that simply reporting what is seen is much easier and quicker than discussing process details such as the times and temperatures with the FBOs (Fairman & Yapp, 2005; Green & Kane, 2014). The inspectors being familiar with the production processes of the inspected establishments may have major significance through the increased possibilities for thorough discussions on process-specific hazards between them and FBOs (Reske et al., 2007; Nevas et al., 2013). However, it may be extremely difficult for an inspector who does not have hands-on experience in different areas of food technology and food production to have the needed knowledge and insight to identify potential problems (Ababouch, 2000; Nielsen, 2006; Green & Kane, 2014). Material including information about the relevant characteristics of processes and equipment, such as the stress points and failure points, should be provided to assist the inspectors (Woodcock, 2014).

2.5.4 Enforcement of food safety rules and enforcement tools in Finland Food control officials may promote good hygiene practices through giving advice and education and through enforcement actions (Garcia Martinez et al., 2007). Based on a survey by Jokela et al. (2009), the majority of food control officials in Finland perceive food safety legislation as providing sufficient means for dealing with non-compliances in establishments. However, proper enforcement is necessary for the adequate functioning of regulations (deJonge et al., 2004; Vapnek & Spreij, 2005; Lepistö & Hänninen, 2011).

Ineffectiveness of official controls may be visible in, for instance, the large numbers of repeated violations relative to the total numbers of violations (Phillips et al., 2006).

Regarding enforcement of food safety rules in Finland, Lundén et al. (2014b) concluded that there is a need for improved enforcement at least in the very severe cases of food safety adulteration.

According to the Finnish Food Act (2006), food control authorities can either demand that the control objects correct the observed non-compliances by solicitation or by using administrative coercive measures. Although the attitudes towards the application of administrative coercive measures are generally positive among Finnish food control officials, sufficient improvements in operations are often considered to be achieved through giving advice and negotiating with the FBOs (Jokela et al., 2009). Correction of non-compliances in Finland is thus largely enforced by means other than coercive measures (Evira, 2015b). However, not all solicitations lead to the desired result, which is

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the main reason for using administrative coercive measures in Finland (Kettunen et al., 2015).

Use of administrative coercive measures has been reduced during the last years in Finland (Evira, 2015b). The most frequent non-compliances leading to the use of administrative coercive measures in food production during 2008-2011 were of an operational nature, and the majority of the decisions involved in the process included non- compliances that have been recognized as risk factors for food-borne outbreaks, e.g. dirty premises, poor condition of surfaces, and temperature abuse (Lundén, 2013). Thus, when coercive measures are used in Finland, there is presumably an adequate indication (Lundén, 2013). However, the coercive measures may not be used on all occasions that would be justified or as rapidly as they should be (Kettunen et al., 2015). In general, use of administrative coercive measures in Finland is relatively infrequent, and readiness to use these measures appears to differ between control units (Jokela et al., 2009; Lepistö &

Hänninen, 2011; Kettunen et al., 2015). Shortcomings have also been reported in the process itself; the legal principles of administration, especially in the hearing process, argumentations of the decisions, and instructions for appeals have been described to be insufficiently fulfilled (Lepistö & Hänninen, 2009, 2011). Reasons such as insecurity, lack of skills/expertise, and complexity of the process have been noted for the inadequate application of the coercive measures (Lepistö & Hänninen, 2009, 2011).

2.5.5 Public access to inspection results

Providing public access to inspection results is one way to force food businesses to take responsibility for food safety (Simon et al., 2005; Nielsen, 2006). Public access to inspection results is effective in increasing the transparency of official food controls and strengthens the trust between consumers and food control authorities (Papadopoulos et al., 2012). Publicly accessible inspection results also increase the willingness of FBOs to comply with food safety rules and to correct the non-compliances observed by food control officials (Fielding et al., 2001; Jin & Leslie, 2003; Thompson et al., 2005; Jin &

Leslie, 2009). However, criticism regarding the implemented systems has also been expressed concerning insufficient substantial consistency in inspections and given grades not being based on the predetermined criteria (Ho, 2012).

Showing inspection results of restaurants openly to customers has an impact on their restaurant choices because the fear of food poisoning increases with increasing number of reported non-compliances (Jin & Leslie, 2003; Henson et al., 2006; Choi et al., 2011).

However, awareness of consumers regarding the limitations of regulatory inspections in disease prevention should be increased since they widely lack knowledge of the fact that inspectors gather only a brief snapshot of conditions (Jones & Grimm, 2008; Leisner et al., 2014). Additionally, understanding regarding the inspection scores should be increased since consumers easily also misinterpret the given information (Nielsen, 2006; Jones &

Grimm, 2008; Leisner et al., 2014). An essential requirement for publication of inspection reports is consistency of inspection criteria and enforcement (Seiver & Hatfield, 2000;

Griffith, 2005; Papadopoulos et al., 2012). With a well-developed program, consistency of

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official controls can be improved, leading also to FBOs perceiving official controls as fairer and more impartial (Thompson et al., 2005).

In the absence of food scandals, food safety in general is taken for granted by consumers (Angulo & Gil, 2007). However, most consumers are subjected to information about food safety hazards from a variety of sources, such as the media, government, retailers and consumer organizations (Lobb et al., 2007). Effectiveness of these messages depends on the extent to which people trust the source (Röhr et al., 2005). Consumer trust in food safety is affected by consumer trust in regulatory institutions and in participants of the food chain (de Jonge et al., 2004). A strength of the Finnish society is that the citizens have confidence in public sector organizations and societal institutions (Salminen & Ikola- Norrbacka, 2010). However, this trust can diminish if administration is experienced as too distant or ineffective (Salminen & Ikola-Norrbacka, 2010). Governments need to ensure consistency and quality of food safety programs and transparency in their communication to enhance public trust (Jensen & Sandoe, 2002; Kriflik & Yeatman, 2005; Worsfold, 2006; Papadopoulos et al., 2012).

2.5.6 Consistency of official controls

Regulation EC No 882/2004 has an important role in creating a uniform approach to official controls in all member states. However, the application of regulations is based on the judgment of the inspector, making the official inspector one of the variables that may affect inspection outcome (Seiver & Hatfield, 2000; Jones et al., 2004; Lee et al., 2012).

Knowledge and experience of inspectors vary, and significant variability may also exist in the types of activities in which the inspectors engage during inspections (Selman & Green, 2008; Lee et al., 2012; Woodcock, 2014). These differences may result in differing probabilities to observe violations in general or to observe some particular violations, and may thus lead to inspector-dependent under- or over-reporting of violations (Lee et al., 2012). Regional differences have also been reported regarding inspection scores in general and the rates of documenting critical violations (Jones et al., 2004; Phillips et al., 2006).

Risk of unequal treatment of FBOs depending on their geographical location has been discussed in Finland due to the varying practices regarding collected control fees, risk evaluation, and use of administrative coercive measures among municipal food control authorities (Tähkäpää et al., 2009; Lepistö et al., 2010; Tähkäpää et al., 2013). However, the consistency of the inspection processes themselves has not been studied. Additionally, the factors that may affect the inspection processes, and thus, eventually the efficacy of the official food controls have not been investigated.

The observed inconsistencies in official food controls have led to recommendations to standardize inspection systems (Jones et al., 2004, Thompson et al., 2005;

Hadjichristodoulou et al., 2008). However, inspections performed by a single observer are difficult to standardize and easily influenced by subjective interpretation (Jones et al., 2004). Periodic retraining of the inspectors should be emphasized, and the observed differences in documentation of violations among them should be used in identifying the training needs (Jones et al., 2004; Lee et al., 2012).

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Differences in documented violation rates also depend on actual differences among establishments (Phillips et al., 2006). It has, for example, been shown, that both inspection activities and explaining the needed corrective actions to food handlers and operators take a longer time in food establishments with inadequate hygiene standards than in establishments with better hygiene (Hadjichristodoulou et al., 2008). The diversity of food establishments and the various situations in them during the inspections also limit the possibilities to predefine the inspection task (Woodcock, 2014), rendering thorough education and provision of precise guidance highly challenging.

2.5.7 Support mechanisms of official food controls

Previous research in Finland calls for stronger guidance from central authorities to ensure good governance, adequate use of administrative coercive measures, and risk-based use in control frequencies (Lepistö & Hänninen, 2009, 2011; Tähkäpää et al., 2013).

Centralization of meat inspection tasks led to improved access to guidance for food control officials, nevertheless more guidance with interpreting food safety requirements and performing food safety inspections is needed (Kotisalo et al., 2015). In a study by Pham et al. (2012), local food control officials wanted particularly a central online resource for food safety information, and ongoing food safety training. According to the study, efforts should be made to develop online resources such as online newsletters and online clearinghouses (Pham et al., 2012).

Sufficient resources, successful management and communication, and adequate education, information, and training are key challenges for the functionality of routine official controls and outbreak investigation (Selman & Green, 2008; Lepistö et al., 2010;

Rostron, 2011). Official food control requires effective project management and coordination, and cooperation and communication within food control authorities and with stakeholders (Rostron, 2011).

2.5.8 Importance of work-related well-being

Work-related well-being of staff is important for the success of a work place. It is characterized by such factors as increased job satisfaction and work engagement and less occupational stress and burnout (Narainsamy & Van Der Westhuizen, 2013). Job satisfaction, organizational commitment, and work engagement are closely linked and are instrumental for general organizational success through increased job performance and decreased turnover intentions (Meyer et al., 2002; Jaramillo et al., 2005; Rose et al., 2009;

Alarcon & Edwards, 2011; Brunetto et al., 2012; Mache et al., 2014). Job satisfaction is also a significant determinant in the intention to retire later, thus prolonging one’s career (Kautonen et al., 2012). However, the operational functionality of food control units and the work-related well-being of their staff have not been previously studied in relation to the impact of control actions.

Enhancing the efficacy of local official food controls in Finland